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Learn more about Rehab, Sports Medicine & Performance


Ladder Matters

Moving well is a combination of balance, coordination, strength, and power.  During everyday tasks, you must be able to plant, pivot, and shift your bodyweight over one leg to change directions or decelerate an impact.  Movement is a skill that we all take for granted until the day that it fails us.  “I can’t believe I can’t do that,” is commonly heard from people in physical therapy.  They are unaware of the level of motor control they have lost to age, injury, and a sedentary lifestyle.  The good news is that with some consistent training, most motor control skills can be restored.  For gym members, an excellent method of enhancing movement skills is the agility ladder.

Agility ladders help you move better.  How you move says more about your age than how you look.  Responsive legs that can react to a disruption in balance keep you durable and injury free.  Consistent agility ladder training develops the neural coordination that allows more graceful movement.

Rotation is the movement pattern that creates the distance in your golf drive, the pop in your punch, and the acceleration in your sprint.  Rotation is the missing movement pattern in most training programs.  Ladder drills improve cross body, shoulder, and hip rotation.

Ladders are the rehab bridge that allows the injured athlete to move from a controlled series of movement patterns to the chaos of competition.  Ladders are one of the best power production and injury prevention activities older clients can perform.

As a conditioning method, I call ladder drills “three-dimensional jump rope”.   Move through a few sixty second intervals of continuous ladder drills and your body heats up, respiration increases, and your metabolism is disrupted.  Ramp that up to 90 seconds and check your heart rate.  See video of agility ladder drills: https://youtu.be/CmLXGLeyGfE

Michael S. O’Hara, PT, OCS, CSCS

The pelvis and spine must be able to stay stable during reciprocal hip (one hip flexed and the other extended) movement patterns.  Walking, running, and sprinting are all reciprocal hip movement activities that require core coordination and isometric strength-endurance.  You can improve this skill with the Half-Kneeling Pallof Press.

Exercising from the half-kneeling position has multiple benefits:  It will improve your posture when you walk or run.  You need the split stance position to get up off the floor.  Becoming stronger in the half-kneeling position makes you a more efficient athlete and improves balance.  It creates a buffer zone of functional mobility and strength so you are less likely to suffer an injury.  Half-kneeling is the antidote for the physical damage produced by prolonged sitting.

Half-Kneeling Pallof Press Performance

Assume a half-kneeling position:  Place your left knee on an Airex pad and position the right foot in line with the right hip.  The left foot is dorsiflexed and the toes dig into the floor to stabilize the leg.  Keep the torso tall and the lumbar spine in neutral.

Resistance tubing is the most convenient tool for this exercise, but you can also use a cable column.  In the half-kneeling position, you set the tubing at chest level.  Align your body so the tubing is directly to your left.  Use a double overlap grip on the handle.  Start with the handle against the sternum and press the tubing out to arms-length and then back to the chest.  Stay tall and stable and do not let the resistance from the tubing pull you into rotation.  The legs should not move. To encourage stability, imagine you have a cup of water resting on the top of the right knee.

Select a resistance level that permits execution of all repetitions without losing the set up posture.  Switch to half-kneeling on the right and repeat the exercise.  If one side of the body is more difficult, start the exercise on that side.  Perform two sets of fifteen repetitions on each side.

I have found that this exercise works well when programmed with the Bird Dog exercise (see post from 5/12/15).  The Half-Kneeling Pallof Press is an upright Bird Dog that progresses the demands of rotation control.  For better posture, improved performance, and injury prevention travel through this exercise series two times:

1.         Bird Dog x 10 repetitions each side- hold ten seconds

2.         Half Kneeling Pallof Press x 15 each side

3.         Stir the Pot x 30 seconds

Physical Therapist, John Pallof – We Thank You!

To view video demonstration of the Half-Kneeling Pallof Press, click on the link below:


-Michael O’Hara, P.T., OCS, CSCS

Most of the fitness clients I work with want better posture, movement, and performance.   Most of the physical therapy patients I work with want their pain to go away and never come back.  Almost everyone has heard that having strong abdominal muscles is a good thing.  Many well-intentioned fitness enthusiasts injure their lower backs and ruin their posture with improper abdominal exercise activities.  A simple exercise that fixes all of these problems is the Bird Dog.

Bird Dogs Build Core Coordination

The spinal column is controlled by a cylinder of muscles made up of the abdominal muscles in the front and sides, the lumbar muscles in the back, the pelvic floor on the bottom, and the respiratory muscle (diaphragm) on the top.  These muscles never work in isolation.  They function as part of a coordinated team to transfer forces and create joint stability.  Core coordination is essential for better movement and pain-free living.

Bird Dogs Reverse Spine Muscle Atrophy

Each lumbar vertebrae is covered by layers of interwoven muscles that travel in multiple directions.  Ultrasound imaging of the muscles around an injured spinal segment- dx sprain, bulge, post-surgery, slipped disc, lumbago, etc.—reveal that atrophy (shrinkage) of the muscles can set in fairly quickly.  Long after the pain has resolved, the atrophy will persist unless some sort of rehabilitative training is performed.  Bird dogs build these atrophied muscles back to normal size and strength.

Bird Dogs Help You Move

Every time you exercise, your neural system uploads motor control patterns that, for better or worse, alter how you move.  Save good patterns and you move better, save bad patterns and you move worse.   The Bird Dog exercise reinforces the opposite shoulder to hip connection through a stable and resilient spine.  We need this pattern of movement to successfully throw a punch, toss a ball, and save us from a fall.

“But I Don’t Feel The Burn.” 

This is the statement I often get from the patient laying on the treatment table with back pain.  They are reluctant to abandon the traditional sit ups, crunches, and various versions of disk herniating spinal flexion exercises that have helped them return to physical therapy.  I don’t believe the sensations that occur with fifty crunches are the abdominal muscles singing.  I think the abdominal muscles are screaming “Where are my teammates?” and “Would you please stop?”   

Bird Dog Performance

Set up in a quadruped position, the hands under the shoulders and the knees under the hips.  Your fingers are facing forward and the elbows are slightly flexed.  It is important to keep your neck in line with your body– do not look down towards your chest or up towards the ceiling.  Brace the abdominal muscles and hold your back stationary.  Lift the right arm into the air to a point 45° off the midline of the body.  Make sure to lead with the thumb.  Extend the left leg backward by hinging at the hip.  Push out through the heel of the foot and do not let the hip rotate outward.  Keep the body stable and hold this position for 5 seconds.  Now perform the same motion with the left arm and right leg.

Start with five repetitions of five seconds on each side and gradually ramp up the duration of the holds to ten seconds.  As ten second holds become easy, add a resistance band to the exercise.  Before adding duration or resistance to the bird dog, become more graceful and steady through the exercise.  Program two or three sets of the Bird Dog into your training sessions.

Be mindful of your performance of the Bird Dog.  Pay attention to how your body moves and feels during the exercise.  Use a mirror to monitor the position of your spine.  The lower back should stay still as the arms and legs move.  The body should not rotate or wobble.  Do not point the toes- keep the ankle dorsiflexed and push out with the heel by actively contracting the gluteals and hamstrings.  As you get better at the exercise, you should feel a better connection of the shoulder girdle to the torso and hips to the pelvis.

Mastery of the Bird Dog takes time.  Work on this exercise for six weeks and I believe you will be surprised by the changes in pain and movement capacity.

To view video demonstration of the Bird Dog, click on the link below:


-Michael O’Hara, P.T., OCS, CSCS

“It’s what you learn after you know it all that counts.” –John Wooden

Amy Warner, Jeff Tirrell, and I recently attended the three day Perform Better Summit in Chicago.  This gathering showcases presentations from experts in the fields of fitness, sports medicine, athletic training, nutrition, and rehabilitation.  All of these presenters work with clients and patients on a daily basis and, as is often the case, their “in the trenches” experience precedes the findings of research studies.  I attend the Summit every year and always walk away with new ideas and knowledge.  We present a brief review of some of the more memorable aspects of the presentations.

Training Athletes In GroupsIMG_1847

Mike Boyle, Body By Boyle Performance Centers and Strength Coach for the Boston Red Sox

  • Know and be able to teach a progression and, more importantly, a regression of every exercise.
  • Don’t put load on top of poor movement.  If the movement looks bad you must fix it before you load it.
  • If you are not foam rolling your athletes, you are a dumbass!
  • Power training is essential if you train older adults, but you must choose the appropriate method.  Know the risk / benefit ratio of your power activity selection.
  • The purpose of the program is to reduce injuries and improve performance.  We are not trying to create power lifters, Olympic lifters, bodybuilders, or strongmen.  We are trying to create athletes.  Strength training is simply a means to an end.

The Best Functional Exercises In the World

Gray Cook, MPT, OCS, CSCS, Co-Founder of the Functional Movement Screen

We need functional exercise because we erode our environment to make life easier:

  • Posture fails because we slouch in chairs.
  • Endurance falters because we simply do more of it instead of performing it better.
  • Coordination dissipates because we train in a supported state or, worse, sitting down.
  • Strength is blunted as we perform all tasks with exterior support and easy access handles.


1. Balance beam

2. Bottoms up kettlebell activities

3. Farmers carry

4. Indian club exercises

5. Jump rope

6. Bear crawl—especially uphill

7. Turkish Get Up

8. Overhead carries


1. Push ups

2. Pull ups

3. Deadlifts

4. Push press

5. Sprints

6. Agility work—physical jigsaw puzzle

Cracking the Coordination Code: Pre Pubescent Athletes

Brett Klika, CSCS, Creator of Spiderfitkids

  • Coordination is how the brain synchronizes and controls movements through muscular activation. It is a set of physical skills that can be practiced, learned and improved.
  • Neural plasticity is at a high point between ages six and twelve.
  • PAWs–Preferential Adaptation Windows– are age phases in which certain coordinative skills can be preferentially developed.
  • Accelerated periods of brain maturation: 15-24 months, 6-8years, 10-12 years, 18 years.
  • If you take children and enhance their movement efficiency and performance, then you increase the likelihood of participation, reduce the propensity to become obese, and make injury less of a concern.

How To Develop Agile Strength

Michol Dalcourt, University of Alberta Exercise Physiologist, Founder and Director of the Institute of Motion, Creator of the Vipr

  • The shape and stability of the human body is produced by the myofascia systems that are woven through the body.
  • The layers of fascia are connected to the nerves that transmit signals of tensile stress and compression that occur as we move.
  • Muscles rely on nerve sensitivity and nerves rely on the fascial sensitivity.
  • Agile strength involves loading and unloading the myofascial lines is a three dimensional activity that trains the muscles, nerves and fascial systems to work together as a team.
  • Athletic activities are multiplanar and three dimensional, but most training is uniplanar and one dimensional.
  • Get better at creating better fascia-nerve-muscle communication and you become better at all activities.  Not just weight room strong but farm boy strong.

Paleo, Vegan, Intermittent Fasting: What’s the Best Diet?

Dr. John Berardi, PhD, CSCS, Founder of Precision Nutrition–my favorite source for nutrition information

  • There’s no such thing as a universal best diet.
  • Most popular diets have a lot in common.
  • Coaches should never lock into a single philosophy.
  • Habit-based coaching is better than diet-based coaching.
  • Proper nutritional coaching involves formulating a plan based on your needs, what you want to accomplish, how you live, and what is personally important.

-Michael O’Hara, P.T., OCS, CSCS